Purpose: The purpose of the present study was to assess current status of knowledge and attitude regarding preventive options in oral care among dentists in Davangere city, Karnataka, India. Materials and Methods: A cross-sectional questionnaire-based survey was adopted to carry out the study among 97 practising dentists in the city. Data on preventive options in oral care was collected by means of 26 self-administered knowledge-, attitude-, and practice-based questions. Microsoft excel and Statistical Package of Social Sciences (SPSS) software were used for statistical analysis of the data collected. Statistical evaluation was done by Chi-square test. Results: Among 97 respondents, 91 (93.80%) were aware of preventive dentistry and 88 (90.7%) were aware that initial lesions can be remineralized. Forty-eight (49.5%) of the respondents were aware that Casein Phosphopeptide and 93 (95.90%) were aware that tooth mousse can be used as remineralizing agent. A total of 53.95% respondents correctly answered the knowledge-based questions. Statistically significant differences were found (P < 0.05) between variables like professional reading and responses. There were no associations found between gender, age, practice location, years of experience, practice type, and participation in continuing dental education programs. Conclusions: The result of this study demonstrated the need to increase the emphasis on preventive dentistry education. It alarms the need to carry out a continuing dental education programs for practising dentists in order to update dentists' knowledge and attitude regarding preventive dental care .

Dental caries and periodontal disease have historically been considered the most important global health burdens. At present, the distribution and severity vary in different parts of the world and within the same country or region. [1] Epidemiological data show that the prevalence of dental caries in most developed countries has declined in recent decades and it has been suggested that it is due to influence of multiple factors including use of fluoride, enhanced oral hygiene including brushing and flossing, dietary changes, and specific procedure performed in dentists office such as routine examination including diagnostic radiographs, scaling and polishing, fluoride applications, and sealants. [2],[3]

Despite the fact that the majority of oral diseases are preventable, dental services currently focus primarily on the treatment of existing disease. Successful preventive dentistry requires that it is comprehensive and includes both chair side and counselling procedures. [4] Dentists are the persons who convey evidences-based knowledge of oral healthcare to public; they influence majorly their patients oral health-related behavior. [5] Thus dentists need to update their knowledge, change their attitude, and practice toward newer prevention-based strategies.

Preventive approach in modern dental practice has been cited as major reason for caries decline in recent decades and also as a predominant part of service-mix of dental practice in the future. The reorientation of oral health services toward prevention and health promotion is one of World Health Organization's (WHO's) priority action for continuous improvement of oral health. [6]

Preventive approach can reduce the burden of oral health problems, as cited by WHO. [1] Literature shows that although the knowledge of dentists may be good, there are certain limitations to the application of preventive approach, lack of positive attitude and implications in daily practice. With this background, the present study aimed to evaluate dentist's knowledge and attitudes toward preventive options in oral care in relation to their age, gender, and professional characteristics.

Materials and methods

Design and sampling

The present descriptive study is a self designed questionnaire-based cross-sectional survey of dentists in Davangere city, Karnataka, India carried out in the month of September 2012.

The questionnaire was divided into two sections which collected the information as follows:

Section A assessed the demography of the respondents-gender, age, practice location, type of practice, years of experience in the profession, and participation in continuing dental education programs.

Section B was made up of 26 questions which focussed on knowledge-based questions regarding preventive care options, attitude-based questions eliciting what the dentists feel about such strategies, and practice-based questions to judge whether they incorporate these strategies in their daily practice.

Majority of questions were closed ended (22 in number) where the respondents were expected to put a tick sign to the options they feel most relevant. Only four questions were open-ended.

The purpose of the study and the procedure to fill up the questionnaire was explained to the participants.

The survey questionnaire was pilot studied on few practising dentists to detect any flaws, validity, and reliability of the questions in the questionnaire instrument. No such flaws were encountered and the main study proceeded. Written permission was obtained from the Principal of the institute prior to the start of the study. The survey was anonymous and participation was voluntary. Dentists were given a choice and those who did not want to participate voluntarily were excluded from the survey; however, there were no dentists who refrained from participating in the survey.

The self-completed questionnaire was distributed to 104 dentists practicing in Davangere City, list of which was obtained from Indian Dental Association (IDA) office of the city. Out of 104 registered dentists, 97 (93.26%) questionnaire were collected back, with two rounds of follow-ups.

Statistical procedure

The filled questionnaire forms were collected from the respondents and were coded. All closed-ended questions were coded with numericals against responses. All open-ended questions were coded as 1 for correct response and 2 for wrong response. The data was entered into Microsoft excel sheet. This sheet was then analyzed using Statistical Packages for Social Sciences (SPSS), version 17.0 software. (SPSS Inc, Chicago). Results were expressed as number and percentage of respondents for each question. The test for significance to find out association between various variables was done using Chi-square test. P ≤ 0.05 was considered statistically significant. Confidence interval was set to 95%.

Results

A total of 97 questionnaires out of 104 were returned by the dentists who completed the survey, providing a response rate of 93.26%. The demographic characteristics and practice profile of the respondents is presented in [Table 1]. [Table 2] shows the responses obtained against various questions presented in the form of numbers and percentages [Figure 1][Figure 2][Figure 3].

Chi-square test was applied to know if test to find out whether association exists between the variables like gender, age, practice location, practice type, years of experience in the profession, professional reading, and participation in continuing dental education programs. There were statistically significant differences found (P < 0.05) between variables like professional reading and responses which are presented in [Table 3]. There were no associations found between gender, age, practice location, years of experience, practice type, and participation in continuing dental education programs.

Table 3: Comparison of various questions versus professional reading (only significant differences have been presented)

The results of the present study reflected that the dentists are generally aware of remineralization options for demineralized teeth like CPP [7] (49.5% aware) and tooth mousse [8] (95.9% aware). One of the reasons for increased awareness about commercial products like CPP and tooth mousse could be because of frequent reminders and promotions by pharmaceutical company or product manufacturers' representatives.

They also acknowledge that frequency of sugars has an important role in dental caries production rather than amount (64.9%). Increased frequency of consumption of sugar in-between meals was associated with a marked increase in dental caries. [9]

Poor knowledge is reflected from several questions like knowledge about CAMBRA [5] where 66.0% of the respondents were not aware of it. Similarly, when responses about knowledge of Council on Clinical Affairs (CAT) 2012) are seen, 80 of the respondents (82.5%) did not answer it correctly and for Arrest of Caries Technique (ACT), [10] 88 respondents (90.7%) answered it wrong. CAMBRA, stands for "Caries Management By Risk Assessment" with its preventive and chemical strategies, is truly the cornerstone of minimally invasive dentistry. [5] Caries-Risk Assessment Tool (CAT) was given by American Academy of Pediatric Dentistry (AAPD), Council on Clinical Affairs 2012 ACT presents an alternative set of appropriate oral healthcare technologies for the disadvantaged communities. [10] These terms are frequently encountered as one keeps updated or is much into professional reading or upon attending continuing dental education programs (CDEs).

When Chi-square test is applied, we find that there is a highly significant difference in the responses when variables like professional reading, participation in continuing dental education programs or practice type is considered (P < 0.01).

There was a highly significant difference between the responses when professional reading was compared with the responses for several questions. It was seen that respondents who were more involved in professional reading has better knowledge than those who did not. For example, the question "Are there any recent caries diagnosis systems" was answered better by the respondents involved more in professional reading. (P = 0.000). Also awareness of tooth-friendly sweets was more among respondents involved more in professional reading (P = 0.001). However, there were no associations found between gender, age, practice location, and years of experience.

Awareness and knowledge about tooth-friendly sugars was seen in 67 of the respondents (69.1%). However, they lacked knowledge about Saturday Sweets Day. [11] This is a type of intervention where children are advised to have all sweets on a single day, mostly on a Saturday afternoon with lunch, to reduce frequent and multiple sugar exposures throughout the week.

However, in spite of having knowledge about advanced caries diagnosis systems (80.4%), a majority of them (96.90%) still rely on conventional caries diagnosis methods. A majority of the dentists do not perform caries activity tests for their patients (n = 72, 74.2%). Caries activity tests like Ora test are found to be a simple chair side, less time consuming, and inexpensive tests. Caries activity tests facilitate the clinical management of patients as they determine the need and extent of personalized preventive measures. [12]

A majority of the respondents use a sharp explorer for examining carious lesions (n = 69, 71.1%). The use of a sharp explorer is not necessary because it does not add to accuracy of the detection and it may damage the enamel surface covering early carious lesions. [13]

Dentist's knowledge of preventive dental care has been shown to diminish as time passes after graduation. [6] Looking at the demographic characteristics and the practice profile of the respondents, it can be concluded that a majority of the practising dentists were of the middle age (n = 50), along with that they had an average of 5-10 years of experience in the profession, indicating that their knowledge in the field must be fresh. Also a majority were private practitioners (n = 68), indicating that chances of being in touch with recent advances and updated knowledge is little unless they do more of professional reading or participate in continuing dental education programs. This suggests a need for appropriate continuing education programs. Also the content and method of delivery plays an important role.

Ninety respondents felt that practising preventive dentistry is for the betterment of their patients and 85 of them felt that such a practice gives morally sound satisfaction; however, a lack of positive attitude or some sort of barrier or difficulty was seen in the dentist's ability to practice preventive dentistry. Eighty-five (87.6%) of the respondents felt a need to participate in some courses for preventive dentistry.

Such courses should be encouraged by bodies like universities, dentists associations, teaching institutes for the upgradation of the knowledge, and to alter the attitudes of practising dentists toward preventive dentistry.

The present study showed only 53.95% knowledge level among the practising dentists in Davangere city, Karnataka, India. The results of the present study are similar to those in a study conducted on Iranian Dentists where there was a need felt to improve the dentists' knowledge of and attitudes toward prevention and keep them updated to enable and encourage them to provide their patients with preventive care. [6] Also, the results of the present study are similar to a study conducted in North Carolina where a number of barriers in primary care medical practices were associated with the adoption and implementation of preventive dental procedures. [14] However, the results could not be truly compared because of the difference in study design and respondents. The results of the present study are similar to those of a study conducted by Nuca C. I. [4] Where there was a need to improve the delivery of preventive dentistry, also a change in the mentality and ideas of providers (dentists) was needed. A study conducted on Ontario dentists [15] found high level of knowledge but lacked awareness and positive attitude. Also pediatricians' knowledge attitude and behavior (KABs) were found to be unsatisfactory in a study conducted at Saudi Arabia. [16] It was observed that the concept of oral health prevention was deficient. Pediatricians' awareness of fissure sealants, fluoride, dietary counselling, time of first dental visits, and thumb sucking were quite limited. Pediatricians' knowledge was significantly lower than their attitude and behavior's scores. These results cannot be truly compared to those of the present study because of differences in the target population.

To keep a pace with the ever changing and improving scientific knowledge in the field of dentistry, dentists must remain updated. Accurate knowledge will enable dentists to make appropriate decisions on their patients' health. The results of the present study indicate that there is a need to increase the awareness and knowledge of the dentists. Preventive dentistry is taught in several individual courses, but there is no individual course per se. Continuing education is more likely to change dentists' knowledge than attitude and behavior as indicated from various studies conducted. [3] Also practicing dentists should be encouraged tailor preventive recommendations to the individual patient's risk for dental disease. [2]

One of the limitations of the present study is that it was carried out only in one city; the authors recommend that such studies be carried out on a nation-wide basis to alarm the authorities in making and implementing a course of action for updating the knowledge of practising dentists in the country.

Conclusion

In conclusion, this study suggests that there is a need to integrate a more comprehensive preventive dentistry program into the dental curriculum and into continuing dental education programs. Further research would be needed to assess the outcome and impact of such interventions. Also a need to improve dentists' knowledge and attitudes toward prevention to enable them to provide their patients with preventive care and re-enforce positive attitude for the same.